Fluid & Electrolytes Flashcards
Fluid therapy for a 16-year-old female trauma patient who has head trauma and suspected cerebral edema following an automobile accident. Would you give Albumin OR Mannitol?
Mannitol: Mannitol is an osmotic diuretic that decreases cerebral edema. Albumin is a protein that draws fluid into the vascular space and would make cerebral edema worse.
Fluid therapy for a 22-year-old female patient who is pregnant and admitted with hyperemesis gravidarum after vomiting for the last seven days. Would you give Colloid OR Cyrstalcolloid?
Crystalcolloid: The use of colloid therapy would be contraindicated because fluid would pull from the extravascular to the intravascular space. Instead you want to rehydrate the cells
Fluid requirement for a 58-year-old male patient admitted with hypokalemia who requires intravenous potassium replacement therapy. Give K+ IV bolus OR K+ IV solution?
K+ IV Solution: Potassium replacement therapy is considered a high-alert medication and should never be administered as an IVP bolus, which could cause dysrhythmias and cardiac arrest
Fluid replacement therapy for an 80-year-old male patient who is hypotensive. Would you give 3% NS or NS?
NS: An isotonic fluid would be indicated for replacement therapy for a hypotensive elderly patient to fill the vascular space. Three percent normal saline is a hypertonic solution and would cause fluid shifting and worsen cellular dehydration.
Fluid replacement for an 18-year-old male patient with a normal blood pressure, experiencing leg cramps after completing a marathon. Would you give Hyper OR Hypo tonic solution?
Hypo: A hypotonic solution shifts fluid out of the vessels into the cells, which improves the dehydration causing the leg cramps
Treatment for a 45-year-old in hypovolemic shock from blood loss after a gunshot wound. Would you give Albumin OR Mannitol?
Albumin: Albumin expands the vascular space and is not contraindicated in bleeding disorders. Mannitol is an osmotic diuretic and will cause additional fluid loss.
Fluid replacement for a 28-year-old female with severe hyponatremia and low blood pressure from adrenal insufficiency and a lack of aldosterone. Would you give Iso OR Hyper tonic solution?
Hyper: A hypertonic solution will increase serum sodium levels while shifting fluid into the circulation and creating vascular expansion, thereby raising the blood pressure. An isotonic solution would not correct the hyponatremia, only the low blood pressure.
Sodium
135-145 mEq/L
What disorder: HA, Lethargy, Confusion, Seizure, N/V, coma, Neurological symptoms
Hyponatremia
What disorder: Irritability, hypotension, Shallow respirations, Hyperexcitability, Tetany
Hypochloremia
What disorder caused by: Metabolic alkalosis NG suctioning Addison's disease Severe burns Respiratory acidosis
Hypochloremia
Chloride
97-107 mEq/L
Potassium
3.5-5 mEq/L
What disorder caused by:
Renal failure, Metabolic acidosis
Soft tissue injury
Hyperkalemia
What disorder: Generalized fatigue, muscle cramps
Bradycardia, ventricular dysrhythmias
Hyperkalemia
What symptoms will you see if K+ is greater than 6 mEq/L
Narrow and peaked T wave
ST depression
Shortening of ST interval
What symptoms will you see if K+ is 6.5-7.5 mEq/L
Lengthening of PR interval, QRS and QT interval
Decrease in amplitude of R wave
Increase depth of S wave
What lab do you want to order for hyperkalemia?
BUN
Creatinine
Glucose levels
What disorder caused by: Bicarb loss through renal and GI systems FVE Hypernatremia Metabolic acidosis
Hyperchloremia
What disorder: Thirst, coma, seizures, agitation, restlessness, neuromuscular irritability
Hypernatremia
What disorder: Deep rapid respirations Lethargy Tachypnea Decrease LOC Hypertension
Hyperchloremia
What disorder caused by: Gastric suctioning, excessive use of enema, laxatives, or diuretics, hypernatremia
Hypokalemia
Never give __ IV ___
K+ IV push
What disorder: palpitations, N/V, weakness, lethargy
Hypokalemia
Magnesium
1.6-2.2 mEq/L
Magnesium alters effects of __
Ca+
What disorder: tetany, hyperactive reflexes, tremors, Trousseau and Chvosteks, vertigo, high BP and HR, v tach, seizures
Hypomagnesemia
Interventions for Hypermagesemia
Iv hydrations
Loop diuretics
What disorder: Hypotension, arhythmias, loss of deep tendon reflexes, coma, bradycardia
Hypermagnesemia
Calcium
8.2-10.2 mg/dL
Ionized calcium
4.6-5.3 mg/dL
What is calcium regulated by?
Thyroid and Parathyroid
Increase in PTH = __
Increase in calcium
Increase in calcitonin = __
Decrease in calcium levels
Lithium toxicty causes what disorders?
Hypermagnesemia
Hypercalcemia
What disorder caused by: Alcohol abuse, malnutrition, chemotherapy, hypokalemia, hypocalcemia
Hypomagnesemia
What disorder: Excitability of nerves and muscles, muscle spasms, dysphagia, wheezing, bronchspasms, trousseau and Chvostek
Hypocalcemia
Interventions for hypocalcemia:
IV Calcium gluconate
Intervention for hypercalcemia:
NS IV
Loop diuretic
IV biphosphates
Calcitonin
What disorder caused by: malignancies, hyperparathyroidism, lithium, thiazide diuretics, and excessive vitamin A and D
Hypercalcemia
Phosphorus
2.5-4.5 mEq/L
Phosphorus has a ___ relationship with calcium
Inverse
Hypophosphatemia is similar to ___
Hypercalcemia
What disorder caused by: Burns, DKA, excessive antacid use
Hypophosphatemia
Treatment for hypophosphatemia:
Oral/IV Phosphorus
TPN/enteral feeding for dysphagia pt.
Tx for hyperphosphatemia
Phosphate binders
IV NS
Loop diuretics
What disorder: Hyperreflexia Soft tissue calcification Convulsions Bone/joint pain
Hyperphosphatemia
Hyperphosphatemia is similar to:
Hypocalcemia
What disorder: Confusion, tremor, joint stiffness, bone pain, muscle weakness
Hypophosphatemia
NS
Isotonic
D51/2NS
Hypertonic
D5W is ___ outside the vascular space but __ inside the vascular space
D5W is Isotonic outside the vascular space but Hypotonic inside the vascular space
1/2 NS
Hypotonic
What pt. should you use D51/2NS cautiously in?
CHF
Renal failure
Liver failure
You should NEVER admin hypotonic solution to what kind of pt.
Burn pt or Pt. w/ increase ICP
Pt. with cerebral edema needs what kind of IVF?
Hypertonic
What pt. needs hypotonic solution?
DKA
HHS
What is a potential complication when administering a hypertonic solution?
Fluid volume overload
Hypernatremia
What is a potential complication when administering a hypotonic solution?
Worsening hypotension
Increase edema
What is a potential complication when administering a Isotonic solution?
Fluid overload
Generalized edema
What is a potential complication in a pt. with FVD?
Hypovolemic shock
Tx for FVD:
PO fluids
IV replacement: NS
What is a potential complication in a pt. with FVE?
Pulmonary edema
Tx for FVE
Correct underlying cause
Terminating/decreasing IVF
Diuretics
Renal dialysis (renal failure pt.)
Lab for FVE
Hematocrit
BUN
Serum osmolality
Albumin (hypoalbumin present in cirrhosis)
Lab for FVD
Hemoglobin Hematocrit Serum osmolality Creatinine Specific gravity
The nurse is caring for a patient with a potassium level of 2.8 mEq/L. Which assessment change related to this is most concerning?
a. ) lightheaded
b. ) tremors
c. ) bone/joint pain
d. ) palpitations
d.) Palpitations: pt. at risk for lethal dyrhythmias
Pt. with lab values: (K+ 5.1) (Na+ 128) (Mg 1.5) (Ca+ 8.0)
Phos 4.7) (Cl- 96) Priority action:
a.) Pad bedrails and set up suction
b.) Contact provider
c.) Assess for Tousseau and Chvostek
d.) Encourage oral fluids and monitor I and O
a.) Pt. with hyponatremia is at risk for neurological disorientation and can lead to seizures
The nurse is caring for a patient with celiac disease who lacks vitamin D absorption. What conclusion can the nurse make with this assessment finding?
a. ) Pt. severely dehydrated
b. ) Normal findings
c. ) Mag level high
d. ) Calcium level low
d.) Lack of vitamin D absorption or intake will decrease calcium levels
The nurse is admitting a patient with confusion and hallucinations. The laboratory report shows hyponatremia, normal potassium, hypomagnesemia, and hypocalcemia. What priority actions should the nurse take? Select all that apply.
a. ) Neurological assessment
b. ) Assess for irregular pulse
c. ) Implement fall precautions
d. ) Determine how much alcohol pt. drinks
e. ) Evaluate for tremors and muscle weakness
A, B, C, D, E
he nurse is assessing a patient with a positive Chvostek’s sign. Which actions are a priority? Select all that apply
a. ) Assess lung sounds
b. ) Request soft diet
c. ) Evaluate phosphorus levels
d. ) Assess for clots
e. ) Monitor BP and HR
A, B, C
Request soft diets: hypocalcemia can cause difficulty swallowing determine if aspiration risk
A nurse assessing a patient recovering from surgery notices an increased thirst, urine output, and the inability to swallow. The patient’s laboratory report indicates a serum magnesium level of 1.4 mEq/L. What treatment should the nurse request from the healthcare provider?
Mag replacement
The nurse is caring for an older adult who is unable to swallow and receiving a hypertonic nutritional supplement through an enteral tube. The nurse notes that the laboratory report shows hypernatremia. What action should the nurse take?
Monitor weight and Na+ levels: because receiving hypertonic feedings could cause water retention (weight gain) and hypernatremia
The nurse is caring for a patient with adrenal cortex insufficiency (Addison’s disease) with a lack of aldosterone production. Which electrolyte should the nurse monitor most closely?
Sodium
Aldosterone release causes an increase of sodium. When there is a lack of aldosterone there is a lack of sodium. Additionally K+ will increase
The nurse is caring for a patient in metabolic acidosis with a potassium level of 6.0 mEq/L. What is the nurse’s priority action?
a. ) EKG monitor
b. ) Obtain baseline weight
c. ) Deliver spironolactone
d. ) Assess LOC
a.) EKG monitor
Foods high in K+
Fruits Potatoes Tomatoes Avocados Instant coffee Molasses Brazil nuts Banana Spinach Cantaloupe
Foods high in Ca+
Dairy products Canned fish with bones Broccoli/Kale Oranges Eggs Requires vitamin D for best absorption
Foods high in Mg+
Dark green leafy vegetables Whole grains Chocolate pudding, milk, bars Cashews, Almonds, Peanuts Mg2+-containing laxatives and antacids
Foods high in Phos
Milk
Processed foods meats
high-protein foods
Cheese and other dairy products
Foods high in Na+
Potato chips Tomato soup/salsa Frozen vegetables Salad dressings Canned Foods Processed foods
What type of pt will you use caution when giving LR?
Renal pt. because contains electrolytes
Hypotonic fluids can cause vascular ___
Dehydration
What is normal urine output?
30 mL/hr
